Provider Demographics
NPI:1295812899
Name:DAVACHI, KHOSROW (MD)
Entity type:Individual
Prefix:DR
First Name:KHOSROW
Middle Name:
Last Name:DAVACHI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 OLD BRANCH AVE
Mailing Address - Street 2:STE D203
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1611
Mailing Address - Country:US
Mailing Address - Phone:301-868-7121
Mailing Address - Fax:301-868-7968
Practice Address - Street 1:7700 OLD BRANCH AVE STE D203
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1611
Practice Address - Country:US
Practice Address - Phone:301-868-7121
Practice Address - Fax:301-868-7968
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025640207RN0300X
DCMD8172207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0400742OtherUNITED HEALTH CARE
DC0400741OtherUNITED HEALTH CARE
22594OtherKAISER
417465OtherMDIPA/OPTIMUM CHOICE
DC022838200Medicaid
MD205102800Medicaid
DC0771 0001OtherBLUE CHOICE
DC0771 0001OtherCAREFIRST
MD110186422OtherRAILROAD MEDICARE
1212OtherELDER HEALTH
27555OtherPRIORITY PARTNERS
DC409013349OtherRAILROAD MEDICARE
MD30859001OtherCAREFIRST
DC4954OtherHEALTHRITE
VA097999OtherBLUE CROSS
1212OtherELDER HEALTH
MD205102800Medicaid